|
WALL-STENT 22*35
|
Facility
|
IP
|
$6,920.70
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.69 |
| Max. Negotiated Rate |
$6,643.87 |
| Rate for Payer: Aetna Commercial |
$5,328.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,398.15
|
| Rate for Payer: Cash Price |
$3,460.35
|
| Rate for Payer: Cigna Commercial |
$5,744.18
|
| Rate for Payer: First Health Commercial |
$6,574.66
|
| Rate for Payer: Humana Commercial |
$5,882.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,674.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,107.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,076.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,090.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,190.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,384.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.42
|
| Rate for Payer: PHCS Commercial |
$6,643.87
|
| Rate for Payer: United Healthcare All Payer |
$6,090.22
|
|
|
WALL-STENT 22*45
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 22*45
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
WALL-STENT 24*45
|
Facility
|
IP
|
$7,018.82
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.45 |
| Max. Negotiated Rate |
$6,738.07 |
| Rate for Payer: Aetna Commercial |
$5,404.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,474.68
|
| Rate for Payer: Cash Price |
$3,509.41
|
| Rate for Payer: Cigna Commercial |
$5,825.62
|
| Rate for Payer: First Health Commercial |
$6,667.88
|
| Rate for Payer: Humana Commercial |
$5,966.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,755.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,179.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,105.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,176.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,264.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,175.83
|
| Rate for Payer: PHCS Commercial |
$6,738.07
|
| Rate for Payer: United Healthcare All Payer |
$6,176.56
|
|
|
WALL-STENT 24*45
|
Facility
|
OP
|
$7,018.82
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.45 |
| Max. Negotiated Rate |
$6,738.07 |
| Rate for Payer: Aetna Commercial |
$5,404.49
|
| Rate for Payer: Anthem Medicaid |
$2,413.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,474.68
|
| Rate for Payer: Cash Price |
$3,509.41
|
| Rate for Payer: Cigna Commercial |
$5,825.62
|
| Rate for Payer: First Health Commercial |
$6,667.88
|
| Rate for Payer: Humana Commercial |
$5,966.00
|
| Rate for Payer: Humana KY Medicaid |
$2,413.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,438.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,755.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,179.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,105.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,462.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,176.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,264.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,175.83
|
| Rate for Payer: PHCS Commercial |
$6,738.07
|
| Rate for Payer: United Healthcare All Payer |
$6,176.56
|
|
|
WALL-STENT 5*20*160
|
Facility
|
OP
|
$7,277.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.07 |
| Max. Negotiated Rate |
$6,986.36 |
| Rate for Payer: Aetna Commercial |
$5,603.64
|
| Rate for Payer: Anthem Medicaid |
$2,502.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,676.42
|
| Rate for Payer: Cash Price |
$3,638.73
|
| Rate for Payer: Cigna Commercial |
$6,040.29
|
| Rate for Payer: First Health Commercial |
$6,913.59
|
| Rate for Payer: Humana Commercial |
$6,185.84
|
| Rate for Payer: Humana KY Medicaid |
$2,502.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,528.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,967.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,370.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,552.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.01
|
| Rate for Payer: PHCS Commercial |
$6,986.36
|
| Rate for Payer: United Healthcare All Payer |
$6,404.16
|
|
|
WALL-STENT 5*20*160
|
Facility
|
IP
|
$7,277.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.07 |
| Max. Negotiated Rate |
$6,986.36 |
| Rate for Payer: Aetna Commercial |
$5,603.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,676.42
|
| Rate for Payer: Cash Price |
$3,638.73
|
| Rate for Payer: Cigna Commercial |
$6,040.29
|
| Rate for Payer: First Health Commercial |
$6,913.59
|
| Rate for Payer: Humana Commercial |
$6,185.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,967.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,370.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.01
|
| Rate for Payer: PHCS Commercial |
$6,986.36
|
| Rate for Payer: United Healthcare All Payer |
$6,404.16
|
|
|
WALL-STENT 5*20*75
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 5*20*75
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 5*40*160
|
Facility
|
OP
|
$7,277.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.07 |
| Max. Negotiated Rate |
$6,986.36 |
| Rate for Payer: Aetna Commercial |
$5,603.64
|
| Rate for Payer: Anthem Medicaid |
$2,502.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,676.42
|
| Rate for Payer: Cash Price |
$3,638.73
|
| Rate for Payer: Cigna Commercial |
$6,040.29
|
| Rate for Payer: First Health Commercial |
$6,913.59
|
| Rate for Payer: Humana Commercial |
$6,185.84
|
| Rate for Payer: Humana KY Medicaid |
$2,502.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,528.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,967.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,370.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,552.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.01
|
| Rate for Payer: PHCS Commercial |
$6,986.36
|
| Rate for Payer: United Healthcare All Payer |
$6,404.16
|
|
|
WALL-STENT 5*40*160
|
Facility
|
IP
|
$7,277.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$946.07 |
| Max. Negotiated Rate |
$6,986.36 |
| Rate for Payer: Aetna Commercial |
$5,603.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,676.42
|
| Rate for Payer: Cash Price |
$3,638.73
|
| Rate for Payer: Cigna Commercial |
$6,040.29
|
| Rate for Payer: First Health Commercial |
$6,913.59
|
| Rate for Payer: Humana Commercial |
$6,185.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,967.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,370.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,183.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,404.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,455.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$946.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,256.01
|
| Rate for Payer: PHCS Commercial |
$6,986.36
|
| Rate for Payer: United Healthcare All Payer |
$6,404.16
|
|
|
WALL-STENT 6*24*160
|
Facility
|
IP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 6*24*160
|
Facility
|
OP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem Medicaid |
$2,338.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Humana KY Medicaid |
$2,338.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 6*24*75 ILIAC 6F
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 6*24*75 ILIAC 6F
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 6*36*160
|
Facility
|
OP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem Medicaid |
$2,338.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Humana KY Medicaid |
$2,338.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 6*36*160
|
Facility
|
IP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 7*23*100
|
Facility
|
OP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem Medicaid |
$2,348.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Humana KY Medicaid |
$2,348.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,372.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,395.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 7*23*100
|
Facility
|
IP
|
$6,827.99
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.64 |
| Max. Negotiated Rate |
$6,554.87 |
| Rate for Payer: Aetna Commercial |
$5,257.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,325.83
|
| Rate for Payer: Cash Price |
$3,414.00
|
| Rate for Payer: Cigna Commercial |
$5,667.23
|
| Rate for Payer: First Health Commercial |
$6,486.59
|
| Rate for Payer: Humana Commercial |
$5,803.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,598.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,039.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,048.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,008.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,120.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.68
|
| Rate for Payer: PHCS Commercial |
$6,554.87
|
| Rate for Payer: United Healthcare All Payer |
$6,008.63
|
|
|
WALL-STENT 7*23*160
|
Facility
|
OP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem Medicaid |
$2,338.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Humana KY Medicaid |
$2,338.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 7*23*160
|
Facility
|
IP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 7*34*160
|
Facility
|
IP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 7*34*160
|
Facility
|
OP
|
$6,801.13
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.15 |
| Max. Negotiated Rate |
$6,529.08 |
| Rate for Payer: Aetna Commercial |
$5,236.87
|
| Rate for Payer: Anthem Medicaid |
$2,338.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,304.88
|
| Rate for Payer: Cash Price |
$3,400.56
|
| Rate for Payer: Cigna Commercial |
$5,644.94
|
| Rate for Payer: First Health Commercial |
$6,461.07
|
| Rate for Payer: Humana Commercial |
$5,780.96
|
| Rate for Payer: Humana KY Medicaid |
$2,338.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,576.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,984.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,108.35
|
| Rate for Payer: PHCS Commercial |
$6,529.08
|
| Rate for Payer: United Healthcare All Payer |
$5,984.99
|
|
|
WALL-STENT 8*20
|
Facility
|
IP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
|
WALL-STENT 8*20
|
Facility
|
OP
|
$6,485.19
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.07 |
| Max. Negotiated Rate |
$6,225.78 |
| Rate for Payer: Aetna Commercial |
$4,993.60
|
| Rate for Payer: Anthem Medicaid |
$2,230.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,058.45
|
| Rate for Payer: Cash Price |
$3,242.59
|
| Rate for Payer: Cigna Commercial |
$5,382.71
|
| Rate for Payer: First Health Commercial |
$6,160.93
|
| Rate for Payer: Humana Commercial |
$5,512.41
|
| Rate for Payer: Humana KY Medicaid |
$2,230.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,317.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,786.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,706.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,863.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.41
|
| Rate for Payer: PHCS Commercial |
$6,225.78
|
| Rate for Payer: United Healthcare All Payer |
$5,706.97
|
|
